Issues on the Nursings Advocacy due to NHS Scotlands Budget Cut - Essay Example

The Effect of Ethical, Political, and Practice Issues on the Nursing’s Advocacy Due to NHS Scotland’s Budget Cut The healthcare industry has been oneof the most valuable businesses running and it has served a stronghold to biological vulnerability in any demographic. Pizzi (2005) discussed the relationship of providing health care services to different economic factors. He mentioned that a healthier nation can result to greater productivity, longevity and bigger Gross Domestic Product. Truly, the role of health care practitioners play a vital role in the on the socio-economical aspect of a nation. The health care professionals are considered as the soldiers of life and their basic principle of caring has also revolutionized over the years in order to have better health services to the nation. In this scenario, modification to the budget, say for example a new government policy, would affect largely the current system implemented by that particular institution. National Health Service Scotland Budget Cut In the light of a health care worker’s advocacy, ethical, political and practice issues cannot be avoided. In Scotland, one the most recent and major ethical issue arose. It is regarding the proposed budget cuts by National Health Service Scotland among health care institutions. Timmons (2010) reported Scotland’s Prime Minister’s stand regarding budget allocation. He mentioned that there will be “lean times ahead and in this time it will affect the public sector.” Though the budget cuts in the National Health Service is not so unusual, the agency in now in the situation of operating its departments with bare minimum staffing levels and it is hard to imagine if there will be further reductions for service provision. Timmons also reported that over “1,500 nursing and midwifery posts with 669 posts in Greater Glasgow and Clyde and 333 posts in NHS Lothian to be phased out over the next 18 months. These cuts are the result of increases in the costs of non-staffing expenditure.” According to the news article of Alexander (2011), “£1.3 billion in public spending cuts planned by Scotland’s devolved administration for 2011-2012 will cause lasting social devastation, as vital services and welfare provision are dismantled. As yet, its full extent has been concealed by the Scottish National Party (SNP) administration, which, seeking to avoid exposure in the run-up to the May Scottish parliamentary election, has delivered only a one-year budget.” Timmons (2010) mentioned in his editorial in Wounds UK that the thing makes these potential cuts more difficult to accept are the recent quality initiatives from the Department of Health (DH, 2009). He cited the document From Good to Great (DH, 2009), which identifies the service developments that would help improve the quality of service the patient receives while in contact with the National Health Service There was also a high importance placed on patient reported outcome measures (PROMS), which would surely be affected by job losses in key areas, which includes nursing for this matter. What is interesting is that there is a belief that these budget cuts will not affect the patient care or services. The analysts do not have the same optimism in this kind of situation. The impact of the budget cut would likely be felt by most patient care areas like elderly patients which are now increasing in number. Furthermore, the budget cut would limit the institution’s capability to update their knowledge and train their workforce. What results now is a less competitive workforce, thus the welfare of the patient is now sacrifices, Timmons also reported that the members of staff doing more rewarding work is not the real issue, “but to discuss moving nursing to become an all-graduate profession and at the same time try to marginalise core nursing activity, there is surely a dichotomy here. If it is the case that healthcare assistants (HCAs) are to carry out the work of qualified staff, there must also be a call for regulation. It would be unfair to allow HCAs to practice an extended role if the staff nurse in charge was still responsible for their colleagues’ actions, particularly if there are low levels of qualified nursing cover.” Perspectives on Budget Cut We take a closer look in the innards of the healthcare institution to have a better understanding of the effects of any budget kind in the health care institution. The study conducted by Bantz, et. al.(1999) discussed the perspective of nursing executives regarding ethical-economic issues in their industry. A survey was conducted among nurse executives (NEs) in the light to discover how they view a number of related ethical-economic issues. It was found out that the NEs responses to the entire "ethical-economic" survey were contrasted with answers offered to the same tool earlier by staff RNs. The results show that there are several measures that Nurse Executives for the benefit of the health care company that staff nurses do not dispose to agree so well. In the study, one of the questions raised was the impact of limiting the budget on staffing patterns. It was not surprising to see that the staff nurses perceive the budget cut to have a greater negative impact on staff positions and on the quality of patient services. This was in contrast with the nurse executives who see the budget cut as a means of improving the system of the institution and to assimilate austerity in the organization. Although both staff nurses and nursing executives were in favor of taxpayers covering a greater part of the cost of medically indigent care, “when asked if they would be willing to pay higher taxes themselves, slightly less than half of the nurse executives answered in the affirmative while only 17% of the staff nurses indicated a similar willingness.”(Bantz, et. al., 1999). The results of the study indicate that nurse executives conceive that the current health care climate is not the reason of the reduction in nurse staff positions overall or an increased risk of complications. Bantz, et. al. mentioned that the theory universal health is supported, however health care executives are not so eager when talking about meeting the goal of efficient health care. In a few words, it is very hard for them to sacrifice the financial well-being of the health care business. However, the nurse executives did believe that nurse practitioners/advanced practice nurses could provide quality care in a cost-effective manner helping to meet the goal of the changing health care system. In this situation, it is viewed that health care reform is forcing hospitals to provide quality care, including nursing, in a more cost-effective manner. The study described above can be directly to the conditions why NHS Scotland implemented this monumental budget cut. It is imperative to examine well the situation of to improve one’s understanding regarding the implementation of the budget cut, the political and economic situation, and its effects to the different sectors. The Position of Professional Nurses in the Political Battle The budget cut bids the patient to endure a limit on the quality of service he will be receiving and also the health care professional to advance his advocacy as well. In this situation, the Scottish public lost its trust to politicians to protect the Scottish NHS from Budget Cuts. According to a Judith Ross, a nurse in Greater Glassgow, “Nurses have worked well with the Scottish Government to deliver improvements in patient care and we want to continue to do so. All the political parties in the Scottish election are saying things about the NHS to get our votes but, as colleagues in England have done with the coalition government’s reforms, nurses and the public in Scotland will be watching to see that our political leaders follow through on their promises after 5 May.” (RCN, 2011). Also, many organizations were agitated in this apparent financial condition. Scottish authorities have been concerned about the universal reach of healthcare services to its population. But nevertheless the current spate of expenditure cuts amounting to millions of Sterling pounds has come at a time too bad for politicians. Political implications of such cuts border on two broader perspectives. In the first instance, as independent political analysts point out even the private healthcare providers in Scotland have been affected adversely by the current global economic crisis. Therefore advocacy groups within the nursing profession have become more vocal and articulate, thus demanding a total abstinence on expenditure cuts by the government (Whittington, 2008). Assuming that advocacy in nursing is focused on the purely ethical argumentative posture of those groups that advocate government involvement in healthcare provision and then continuous increase in expenditure, there is very little that is shown by such a picture. In fact it effectively hides the economic picture of crises and expenditure related constraints. Compulsions and obsessions have been noticed though on an ever rising scale here. The politics has been subject to a degree of overarching philosophizing by politicians and government officials over the issue. This discourse on health care provision and its shape has divided the nation on clear cut lines of those who have the audacity to argue that public or government provision of health care would be the beginning of the end of all merits associated with private provision and those who argue that government provision of health care services would bring down the cost of medical care (Culyer and Newhouse, 2000). Strategic capabilities of government hospitals partially or wholly depend on this link with their strategic partnership with professionals including the nursing staff. While strategic professional orientation is determined by its own strengths, external influences such as political, economic, social or ethical and technological would determine the hospital’s preparedness to face environment related factors. As for the health care industry political impact on the individual hospital or the service provider could be assessed in a number of ways. The government has a huge political stake in the industry and therefore their own behavior is basically determined by desirable outcomes in the health care sector, as a whole. For instance, the Scottish government needs to focus on setting some priorities for recognizing specific professional policy standards in nursing both in state and private hospitals (Duncan, 2007). All these politically motivated influences would be absorbed by the health care industry at large and other similar players in the industry would be compelled to respond appropriately to these new developments which have both a political and economic impact on the industry. However strategic professional capabilities of nurses coupled with the extent of government subsidies, help hospitals and individual practitioners to position themselves in the industry at an advantageous level vis-à-vis their rivals who might lack such capabilities. Ethical arguments based on helping the poor patient are not in vogue either because government budget deficits running into millions have forced authorities to request the public to tighten their belts. Scottish NHS has produced similar division between supporters and opponents. On the other hand the supporters have more or less been banking their hopes for a successful outcome of the debate in their favor on the classical dichotomy of opinion among those who are opposed to the government becoming a mammoth octopus-like public corporation. Those who believe in the government involvement in the provision of health care are not many though they have been able to win over support of the most unlikely groups over the weeks simply because the opposition is not sure whether there is real substance to the argument put forward by the politicians in the opposing camp. The argument put forward by those who advocate a fully comprehensive set of professional nursing standards in Scottish NHS is based on the fact that there is no excuse for government expenditure cuts on healthcare and it would go so far as to shift resources away from efficient uses to less efficient uses. This has given enough ammunition to the supporters of welfare expenditure by the government, i.e. a shift in resources would weaken the NHS as feared by those who oppose the government’s current policy of healthcare that rests on global trends. They demand a qualitative change in the provision process (Whittington, 2008). In other words it’s a catalyst that would emphasize nursing practice oriented provision of health care thus bringing in all citizens under the protective umbrella of the state health care policy. While the assumption seems to gather some momentum among even the fiercest critics of the government there are those residual elements that still question the motive behind the government’s continuously ballooning healthcare budget. However the rhetoric of both those supporters and opponents on either side of the divide is obvious enough. The whole governmental apparatus would be cluttered with giant service sectors while the quality of service would suffer setbacks (Jahann, 2005). Impact among Nurses The political and economic discussion on the budget cut may seem endless, further it may recur again in the future several times more depending on the economic situation. But at the end of the day, the question still lies on how the different sectors affected are going to cope up in the situation. It was discussed in the earlier parts of this paper the impacts of the budget cut not only to patients but to health care workers as well. One of the direct impacts of budget cut is the staffing pattern for health care practitioners. The Scottish Government revealed that “the smaller increase in the health budget than in previous years will mean a severe reduction in number employed in the Scottish NHS.” (Macleod, 2010). The budget squeeze will result to almost 3,800 NHS jobs disappearing in the financial year. The number of nurses to be hired will definitely decrease and the increase of their salaries would slow down or even stagnate. The work of any health care practitioner especially the nurse require great attention else the worker himself will put his health in peril, and a justifiable salary is needed to equal the services these health care workers provide. In this situation, the nurses are not the only ones who are affected but also the individuals who wish to have good quality nurse care. Another issue is establishing a fine line between nurses and health care aide. Nurses who took a full degree before entering the health care industry can demand for greater compensation compared to health care aides who learned their skills from a few months to 2 years. Now, with the across-the-board budget cut, institutions may decide to modify their staffing pattern by hiring a few nurses only and several health aides whom the nurses will supervise. This is one predicament experienced by most professionals by most private organizations. These private companies modify their staffing pattern to “improve” their systems of management and to maximize the company’s profits. Apparently the government would like to try this modification in their different agencies, in this case is the NHS. Government and private organizations may have similar organizational structure but have different goals and objectives; therefore they have different rationales for every type of implementation. There are also Impacts to nursing education. The higher education sector in general is to receive a 6.7 percent budget cut in 2011-2012. Macleod also reported that “the Scottish Funding Council (SFC) recently translated the cut into academic years revealing an 11 percent, or £69 million, reduction in the teaching budget. Capital funding for universities and colleges will see a fall of 38 percent.” Dr. Tony Axon, a research officer for the Universities and Colleges Union, said, “We’re concerned about the way the funding council is going down that line of almost ghettoizing universities.” Another shocking thing in 2012 is introducing “a graduate contribution tax for Scottish students” and “upfront tuition fees for students from England, Wales and Northern Ireland will be increased from £1,900 to £6,000 per year. The number of fully funded places for Scottish and European Union students will also be reduced.” (Alexander, 2011). Theresa Fyffe of the Royal College of Nursing stated in an interview that “It would also make it difficult and more costly to redesign services to meet patient needs in the future as appropriately skilled nurses and other healthcare professionals may no longer be in the workforce.” Priorities in nursing practice within the Scottish NHS The current nature and extent of priorities in nursing practice within the NHS in Scotland signify a broader level of policy and strategy shift away from government sponsored health plans to private ones. In the process nursing profession has become a victim of government negligence. Thus a set of priorities has to be defined in advance to broaden the understanding of the outcomes. Nursing profession within the NHS has been subject to a series of setbacks as a result of the government’s expenditure cuts on healthcare. The primary reason being adduced by the government is that of the current financial crisis (NHS 2010). McCrone (1998) related health care to consumer electronics industries in terms of prioritization. Prioritizing the use and adoption of Consumer Electronics Association or CEA in the health sector of the country requires a series of qualifying data. An effective CEA should have the capacity for adaptability to the practical treatment environment. In other words isolated or disconnected CEA cannot have the desired results in a completely practical treatment environment where programs tend to be associated with cost and benefits alone. The psychological impact on the patient apart, there could be an attendant divergence of opinion among the health care staff, as to what constitutes moral and non-moral aspects of prioritizing that include nursing advocacy. Despite this claim many critics point out that expenditure cuts have more to do with the government’s general belief that private enterprise is more efficient and cost effective while NHS has become a burden on the taxpayer. There is good substance to this claim, especially taxing more and more an already overburdened taxpayer. According to those who lean on an interpretation based on structural functionalism, the societal system consisting of various individual units such as families has been torn apart by the monopoly power inherent in private health care provision. NHS in Scotland has been more concerned of curtailing subsidizes services including surgical procedures for which specialized nurses are required (The Scottish Government, 2010). References (supplement) Alexpander, S. 2011, Scotland’s Budget Cuts to Slash 125,000 Jobs. World Soicalist Eb Site. Retrieved from http://www.wsws.org/articles/2011/jan2011/scot-j18.shtml Bantz, D., Wieseke A., & Horowitz, J. 1999, Perspectives of Nursing Executives Regarding Ethical-Economic Issues. Ball State University, School of Nursing. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10410026 Macleod, A. 2010. NHS Budget Cuts Put 3,800 Jobs at Risk. Times Online. Retrieved from http://www.timesonline.co.uk/tol/news/uk/scotland/article7143876.ece Professional Nursing Concepts and Issues. 2009, Nursing 410 Syllabus. California State University. Retrieved from Nursing 410 - Syllabus09 - California State University, Bakersfield Public Lack trust in Political Parties’ handling of NHS in Scotland. 2011. Royal College of Nursing (RCN). Retrieved from http://www.rcn.org.uk/newsevents/news/article/scotland/public_lack_trust_in_political_parties_handling_of_nhs_in_scotland Timmons, J. 2010, Service Improvements alongside Budget Cuts: A Dilemma for Tissue Viability. Wounds UK, Vol. 6 No. 2 Page 8. Retrieved from Service improvements alongside budget cuts: a dilemma for tissue ... Read More